Are you interested in fostering or adopting?:* Fostering Adopting Applying for:* First Name* Last Name* Date of Birth* Driver’s License Number Phone Number* Email* Address 1* Address 2 City* State* IllinoisIndianaMichiganWisconsin Zip* Have you lived at this address for at least 2 years?* Yes No If not, previous address Do you own or rent?* Yes No If own, Homeowners Association If rent, Landlord’s Name & Phone Current Occupation* Number of Years at Current Job* Household Information Number of Adults in Household* Number of Children in Household:* Ages of Children* Have children had pets before?* Yes No Have all adults in household agreed to this adoption?* Yes No Does anyone in household have pet allergies?* Yes No If yes, who In general, how would you describe life at your house?* General Pet Information How long have you been looking for a dog?* Is this your first dog?:* Yes No If you have had pets in the past or currently have pets, please describe (name, breed/mix, age, gender, spayed/neutered, living/deceased)* Have you ever given a pet away or relinquished one to a shelter* Yes No If yes, what were the circumstances? Under what circumstances would you, or have you, euthanized a pet?* Current Veterinarian* Veterinarian Address* Veterinarian Phone* New Dog Information Are you committed to owning a dog for the next 10-16 years?* Yes No How will you handle your dogs exercise and bathroom needs?* Do you have a fenced-in yard suitable for a dog?* Yes No If yes, please describe enclosure How long will your dog be left outside unattended?* Who will be your dog’s primary caregiver?* How many hours per day will your dog be without human companionship?:* Where will your dog be kept during the day?* Where will your dog sleep at night?* In case of emergency, who will care for your dog?* What do you plan to feed your dog?* How much time will you allow your dog to adjust to your home?* Are you willing to enroll in obedience training with your dog?* Yes No If your dog is not housebroken, what method of house training will you use?* How will you reprimand unwanted behavior?* What would cause you to return your dog to us?* References How did you hear about us?* Please provide three personal references (name, relationship, phone):* The information on this application will be kept confidential. I certify that all information provided is complete and correct to the best of my knowledge.* Yes No
